Provider Demographics
NPI:1144211483
Name:THRONEBURG, DAVID BRENNEN (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRENNEN
Last Name:THRONEBURG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:B
Other - Last Name:THRONEBURG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2170 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2927
Mailing Address - Country:US
Mailing Address - Phone:910-295-2100
Mailing Address - Fax:910-295-3625
Practice Address - Street 1:2170 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2927
Practice Address - Country:US
Practice Address - Phone:910-295-2100
Practice Address - Fax:910-295-3625
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1693152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2238830OtherUNITED HEALTHCARE
SCDN1693Medicaid
NC0906WOtherBCBS
NCFH7000015OtherFIRSTCAROLINACARE
NC890906WMedicaid
NCNCK7580355OtherMEDICARE
NC180034437OtherRAILROAD MEDICARE
NC368226OtherUSA MANAGED CARE
NC370068OtherMAMSI
NC124971OtherOPTICARE
NC86924OtherMEDCOST
NC368226OtherUSA MANAGED CARE